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Arthroscopy. 2014 Apr;30(4):444-50. doi: 10.1016/j.arthro.2013.12.015.

Primary versus revision arthroscopic reconstruction with remplissage for shoulder instability with moderate bone loss.

Author information

1
Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.
2
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
3
Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A.
4
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A. Electronic address: fsavoie@tulane.edu.

Abstract

PURPOSE:

This study aims to evaluate our outcomes of arthroscopic remplissage in this setting.

METHODS:

A retrospective review was performed to identify patients who underwent arthroscopic remplissage of an engaging Hill-Sachs lesion along with anterior capsulolabral reconstruction for anterior glenohumeral instability with moderate glenohumeral bone loss at our institution. Thirty-five patients, with a minimum of 2 years' follow-up, were identified. We assessed the American Shoulder and Elbow Surgeons score, incidence of recurrent instability, and postoperative Rowe instability score.

RESULTS:

Follow-up was available for 30 patients (31 shoulders). The mean age was 24.6 years, with a mean follow-up period of 41 months. Prior instability surgery had failed in 11 patients, and they underwent capsulolabral reconstruction and remplissage ("revision surgery"). The failure rate in revision cases (36%) was significantly higher than the failure rate in primary surgery cases (0%) (P = .01). Failure resulted from trauma in all 4 patients, and none required further surgery. The mean American Shoulder and Elbow Surgeons score for all patients improved from 50 preoperatively to 91 postoperatively (P < .001), with no significant postoperative difference between primary and revision patients (P = .13). The patients with clinical failure showed nonsignificant improvement from 41 preoperatively to 72 postoperatively (P = .08). The mean postoperative Rowe score for the entire cohort was 90. The Rowe score was significantly lower in the 4 cases of failure than in the 27 non-failure cases (51 v 96, P < .001).

CONCLUSIONS:

In our experience, aggressive capsulolabral reconstruction with remplissage in traumatic instability patients with moderate bone loss and engaging humeral Hill-Sachs lesions yields acceptable outcomes for primary instability surgery. However, a significantly higher failure rate occurred when arthroscopic reconstruction with remplissage was performed in the revision setting.

LEVEL OF EVIDENCE:

Level IV, therapeutic case series.

PMID:
24680304
DOI:
10.1016/j.arthro.2013.12.015
[Indexed for MEDLINE]

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